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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Policy Number: 60471-33-32 <br />POLICY CHANGES <br />Effective Date of Change: 05/11/21 <br />Change Endorsement No.: 005 <br />Named Insured: DKF SOLUTIONS GROUP LLC <br />PATZER RISK CONTROL SERVICES <br />170 DOGWOOD LN <br />C/O DAVID PATZER <br />VALLEJO CA 94591-8056 <br />The following item(s): <br />Expiration Date: 03/19/22 <br />Agent: 96-82-34H <br />E4277 <br />Ist Edition <br />Insured's Name <br />Inures Mailing Address <br />Policy Number <br />Company <br />Effective / Expiration Date <br />Insured's Legal Status / Business of Insured <br />Payment Plan <br />Premium Determination <br />X <br />Additional Interested Parties <br />Coverage Forms and Endorsements <br />Limits / Exposures <br />Deductibles <br />Covered Property / Location Description <br />Classification / Class Codes <br />Rates <br />Underlying Insurance <br />is (are) changed to read {See Additional Page(s)): <br />The above amendments result in a change in the premium as follows: <br />X I No Changes I I To Be Adjusted At Audit <br />Authorized Representative Signature: <br />914977 M NNN 7.09 <br />E4277{Nl <br />Indudm Copyrighted Malarial, Imuion, Services Office, Inc, with i6 penntsim. <br />Additional Premium I Return Premium <br />�'•`� N S Risk MompnodDMd,, <br />RE:Mew &APPROVED Sr. <br />v3.1d111i_li_L, ��Ir<r.c;,E,e �. (7:,(Lvlut[ <br />'. <br />Rlsk Management Analyst <br />